Utah study finds long-term benefits after weight-loss surgery

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Jody Stubler struggled to lose the weight she put on through five pregnancies. Every time she'd succeed, the pounds would come right back. When a similarly sized friend said it was time to accept being fat, Stubler instead turned to weight-loss surgery.

The recreational swimmer wanted to get back into the pool.

Three years ago, she had bariatric surgery. She lost 120 pounds, is no longer considered diabetic and is off medications for high blood pressure and high cholesterol.

"I'm going to enjoy a longer life and enjoy being with my family longer," said the school nurse from South Jordan.

A new Utah study shows those heart-healthy results can be expected with gastric bypass surgery.

Such surgery, in which the stomach is shrunk and food bypasses the small intestine, is considered the only way to achieve substantial, long-term weight loss among the severely obese.

But long-term follow-up of bariatric surgery patients has been limited. The Utah study, published by the Journal of the American Medical Association on Tuesday as part of a special edition on obesity, shows good results even after six years.

Patients in the study maintained most of their initial weight loss. A majority who had type 2 diabetes before surgery, like Stubler, were in remission. And they also had lower blood pressure and cholesterol levels.

"It confirms other studies that have demonstrated bariatric or weight-loss surgery appears to be the most successful treatment or therapy for severely obese individuals," said Ted Adams, a faculty member at the University of Utah School of Medicine and research and clinical director for the Intermountain Health and Fitness Institute at LDS Hospital.

Adams and his colleagues  from the U., Intermountain Healthcare, Rocky Mountain Associated Physicians in Salt Lake City and from institutions in Georgia, North Carolina, New York and North Dakota  tracked the health of 418 patients who had gastric bypass surgery. They compared the patients to control groups of patients who sought the surgery and a random sample of severely obese patients.

Two years after surgery, the patients had lost an average of 35 percent of their initial body weight. By year six, they gained some of it back, for an average loss of 28 percent.

By comparison, the control groups gained a slight amount or lost no weight.

"Thirty-five percent is a lot of weight. That's suggesting that whatever your weight is today, a third of you is no longer there," Adams said. "To maintain that for up to six years, as much as 28 percent of one's weight, is pretty dramatic as well."

He said weight-loss programs based on changing behaviors are considered successful if participants lose just 8 percent of their initial weight.

Among the patients who had diabetes before surgery, 62 percent were in remission at year six, compared with between 6 percent and 8 percent among the control groups.

Patients who didn't go into remission had been living with diabetes longer and their disease was not as well controlled, said Adams, who is starting a 10-year review of surgical patients.

Added Salt Lake City bariatric surgeon Rodrick McKinlay, whose patients were included in the study: "Most of our patients diagnosed with diabetes [five years before surgery] or on oral medication alone would go home from the hospital without the need for diabetic medication and typically stay that way."

And for patients whose diabetes didn't go into remission, McKinlay said they often still benefit from the surgery. They can reduce the amount of insulin they need and have an easier time controlling their blood sugar, which should help them avoid the severe complications of diabetes, including heart attacks and kidney failure.

The study also showed that just 2 percent of surgical patients went on to develop diabetes, compared with 15 percent to 17 percent of the control groups.

About 31 million Americans meet the criteria for bariatric surgery. And while obesity is on the rise, severe obesity is rising even faster.

But the surgery costs around $20,000, and insurance rarely covers all of it. And there are risks. Besides complications including infection, bowel obstruction or malnutrition, the study tracked four suicides among the surgical patients.

Stubler, one of McKinlay's patients but not part of the study, has no regrets. The 60-year-old has gained back about 15 pounds but said she is still at a healthy weight.

While McKinlay says 20 percent of his patients gain half or more of their weight back, Stubler said she took a behavior-modification class to understand her food addiction and deal with her emotions. She counts calories every day  allowing herself 100 calories of junk  and works out an hour a day at least five times a week.

The weight loss has boosted her confidence. She finally started using her master's degree in nursing education to teach nursing students. She was too embarrassed before about her size to apply for jobs.

And she's back in the pool. "I'm not embarrassed to get in a bathing suit anymore."

hmay@sltrib.com 

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